The long-term objectives of this project are to develop a comprehensive, computer-based education program for primary care physicians (PCPs) that will improve their skills in structured substance abuse screening, brief interventions, and referral and treatment (SBIRT). This digital education program will facilitate federal and local efforts to integrate SBIRT into clinical practice by providing a low-cost, easily distributed, and educationally effective alternative to current lecture and workshop-based SBIRT training programs. The educational program will emphasize contextual learning and will be built using innovative virtual patient (VP) technology. An additional innovation will be the use of script concordance theory in the development of the education program as well as a unique and marketable educational assessment tool. During the project we will also evaluate an important theoretical question in medical education, is guided learning more efficient than typical user-directed simulation learning? Standard uses of simulation in medical education, including VPs, often rely on a trial and error approach. There is research evidence from other educational domains that worked examples (guided learning) allow students to more efficiently develop the types of mental schemata ("scripts") that are used by experts. We will compare two VP-based programs to no training in a randomized, controlled trial to determine the differences in educational outcomes between a typical VP program and a guided learning VP program. Our outcome measures will include learning time and performance on a script concordance test that will compare physician knowledge and decision-making skills to those of experts in substance abuse treatment. PUBLIC HEALTH RELEVANCE: This project meets the stated goal of the U.S. National Drug Control Strategy to facilitate the use of structured substance abuse screening, followed by brief interventions, and, if necessary, referral and treatment (SBIRT) by primary care physicians (PCPs). The Substance Abuse and Mental Health Services Administration (SAMHSA) currently sponsors several initiatives designed to improve PCP use of SBIRT, but these initiatives are based on a classroom teaching model. This proposal will develop a scalable, educationally effective SBIRT skills development program that can be nationally deployed and will better meet the needs of community PCPs and physicians in training.